The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Gay, bisexual, and other men who have sex with men (GBM) living with HIV are disproportionately impacted by HPV-associated anal cancer, with rates about 100-fold that of the general population. Fortunately, HPV vaccination has proven efficacy in preventing both anogenital warts (condyloma) in males and anal pre-cancers (anal intraepithelial neoplasia; AIN) in GBM up to the age of 26. We conducted in-depth, semi-structured interviews with 25 HIV-positive gay men in Toronto to gain an understanding of their knowledge and experiences related to HPV and the HPV vaccine. These participants were part of The HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, and received invitations to have anal cancer screening from their primary care doctors. Interviews were analyzed following a Grounded Theory Approach. Most participants had not received the HPV vaccine. Men described a lack of prior knowledge of the health consequences of HPV for GBM living with HIV and financial barriers to vaccine access. Participants did not articulate concerns about vaccine safety. Men frequently reported initial beliefs that HPV was predominantly—or exclusively—a risk for females or young girls, and thus they had not considered the vaccine to be necessary. Some participants remained uncertain if the current availability of the vaccine, and their newly acquired knowledge of its importance, was “too little, too late” because of their age and/or HPV exposure. Improving access and uptake of HPV vaccination requires addressing both financial barriers to access as well as increasing HPV health literacy levels, particularly by reframing the long-standing gendered associations of HPV. Physicians should provide clear, tailored messages regarding HPV vaccination.

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ObjectivesWe explore the hypothesis that using illicit drugs other than, or in addition to, cannabis is associated with sexual risk behaviour and sexual health outcomes in the British population.MethodsWe analysed data, separately by gender, reported by sexually-active participants (those reporting > = 1 partners/past year) aged 16–44 years (3,395 men, 4,980 women) in Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey undertaken 2010–12 involving computer-assisted personal-interview and computer-assisted self-interview. Analyses accounted for the stratification, clustering and weighting of the data. Multivariable logistic regression was used to calculate adjusted odds ratios.ResultsUse of illicit drugs other than, or in addition to, cannabis in the past year was reported by 11.5% (95%CI:10.4%-12.8%) of men and 5.5% (4.8%-6.3%) of women. Use of these types of drugs was more common among those <35 years, those who reported poor general and/or sexual health behaviours, e.g. binge drinking > = weekly (age-adjusted ORs, aAORs, 10.91 (6.27–18.97) men; 9.95 (6.11–16.19) women); having > = 2 condomless partners in the past year (aAOR:5.50 (3.61–8.39) men; 5.24 (3.07–8.94) women). Participants reporting illicit drug use were more likely (than those who did not) to report sexual health clinic attendance (ORs after adjusting for age, sexual identity and partner numbers: 1.79 (1.28–2.51) men; 1.99 (1.34–2.95) women), chlamydia testing (1.42 (1.06–1.92) men; 1.94 (1.40–2.70) women), unplanned pregnancy (2.93 (1.39–6.17) women), and among men only, sexually transmitted infection diagnoses (3.10 (1.63–5.89)).ConclusionsIn Britain, those reporting recent illicit drug use were more likely to report other markers of poor general and sexual health. They were also more likely to attend sexual health clinics so these should be considered appropriate settings to implement holistic interventions to maximise health gain.

ObjectivesAnal human papillomavirus (HPV) infection is highly prevalent among men who have sex with men (MSM). HPV-associated anal dysplasia has been linked with anal HIV RNA shedding despite antiretroviral therapy (ART). Since mucosal HIV levels are a key determinant of sexual transmission of the virus, this would have important public health implications. Therefore, we assessed the association between anal dysplasia and HIV shedding in ART-treated MSM from Toronto, Canada.MethodsIn 54 HIV-infected men on effective ART, we assessed anal HIV RNA shedding by PCR, HPV infection by microsphere-based genotyping and anal dysplasia by high-resolution anoscopy. All participants were enrolled between May 2017 and October 2018.ResultsThe median duration of ART at the time of study enrolment was 18 years, with most participants being on an integrase inhibitor-based ART regimen. Low-level anal HIV RNA shedding was present in 15/54 (27.8%) participants. Neither the detection of shedding nor the level of HIV RNA was associated with anal dysplasia, HPV infection or antiretroviral regimen.ConclusionsHPV-associated anal dysplasia was not associated with anal HIV RNA shedding in this relatively small cohort of men on effective ART. While anal HIV RNA was detected more often than anticipated, shedding was low level and unlikely to cause HIV transmission. However, the immunological drivers of anal HIV RNA shedding in ART-treated individuals may merit further study.

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